1. Crossroads: Newton Stewart and Machars Care Attendant Scheme Anni Telford

2. Project Aims Research current good practice across the UK Examine potential problems for current practice; Examine the added difficulties of personalisation in a rural area; Write a report to share knowledge gained; Formulate aims and objectives in the form of a Development Plan Anni Telford 7/9/20112

3. Research Strategy Survey originally means to obtain information for the purposes of mapping. Three characteristics: – Wide and inclusive coverage – At a specific point in time – Empirical research, getting out there and looking Anni Telford 7/9/2011 3

4. Survey Methodologies Postal survey – difficult for people with dementia type illnesses & poor response rates (Denscombe (2003) response less than 20%). Telephone interviews – difficult for people with dementia type illnesses and hearing impairment. Face to face interviews – costly in terms of time but good for purposive samples and allows easy two way exchange of information. Anni Telford 7/9/2011 4

5. Sample Selection 1 Four distinct categories of service user and three of staff which had to be represented. – Service Users: recipients of home care with physical disabilities; recipients of home care with dementia type problems; recipients of respite care; recipients of personalised care (primarily young people and children). – Staff: providers of home care, respite and personalised services. Probability sampling therefore rejected as too random to ensure good fit. Anni Telford 7/9/2011 5

6. Sample Selection 2 Non-probability purposive sampling chosen. Denscombe (2003) suggests purposive sampling: – a) allows the researcher to focus on instances which display a wide variety – b) is economical and – c) is informative in a way that conventional probability sampling cannot be.(p16) Anni Telford 7/9/2011 6

7. Sample – Service Users 35 service users interviewed representing 29% of Crossroads client group. Representatives drawn at random from each of the four groups. Interviews spread over 7 days. 1.25 hours allowed per interview. Interviews held in service users own home. Anni Telford 7/9/2011 7

8. Sample - Staff Staff invited to select a one hour group slot from a selection of 20 possible slots; 32 responders representing 31% of Crossroads whole time equivalent staff base; All 3 members of management and support team included in staff group; Included staff providing all three forms of service (home care; respite; personalised). Anni Telford 7/9/2011 8

9. Interview Schedule Criteria – had to be fast, easy to understand and use, available to people with a range of physical and psychological disabilities, easy to record in some format. Had to be adaptable for a range of levels of discussion. Had to be able to capture priorities. Anni Telford 7/9/2011 9

10. Service User Interviews Purpose of visit explained Short description of personalisation given Asked about what services they saw as essential; what services they would like to have; what about services was important to them; what would they like to see in services. Answers written on post-it notes Then asked to prioritise responses on high low pyramid. Anni Telford 7/9/2011 10

11. Staff Interviews Purpose of meeting explained. Description of personalisation given and a brief overview of types of service clients asking for. Asked to consider how they felt. Asked to consider what training and support they might need to meet service user asks. Answers written on coloured post-it notes. Then asked to prioritise responses on strong/weak feelings and high/low support priority pyramids. Anni Telford 7/9/2011 11

12. Results – Service Users General 100% of respondents were very positive about the services provided by Crossroads Newton Stewart and Machars Home Care Service; 100% of service users values prioritised personal care (assistance with personal hygiene, nutrition, dressing etc.) highly but different groups then prioritised different aspects of service provision. Anni Telford 7/9/2011 12

13. Service Users Home Care Home Care Physical DisabilityPriority LevelHome Care Dementia Illnesses Gardening Weekend support Companionship Advocacy and advice 1Laundry 7/7 – 365/365 service Bed changing Advocacy and advice Flexibility Staff consistency Transport Outings Housework 2Shopping Housework Companionship Handyman services Flexibility Good office communications Consistent visit times Small staff team 3Good communications Gardening Outings (hairdressers, coffee etc.) Outings Support with health care visits 4Consistent known staff Cheerful Shopping5Professional attitudes Anni Telford 7/9/2011 13

14. Services Users Young People PriorityService 1Age matching of carers; reliability; consistency; overnight support; extra mileage allowance to account for rural setting; mentorship for future career possibilities. 2Weekend support (Saturday night outings); overnight support (attendance at concerts etc. in Glasgow etc.); high flexibility; small, consistent and trustworthy team (involvement in staff appointments). 3Holiday support; range of activities (difficulties with rural setting). 4Focus on treatment rather than just support; good office communications; more involvement with organisational management; 5Confident drivers; problem solvers; all day same person shifts; Wide range of interests and abilities; 24 hour support line; access to pamper days; more family activities and involvement. Anni Telford 7/9/2011 14

15. Service Users Carers PriorityService 1Staff with specific training to deal with specific problems; contribute to staff training on loved ones problems and care; more organised staffing base; advocacy and advice. 2Emergency respite response; evening, weekend and overnight respite; continuity of staff; flexibility of hours and availability. 3Staff with counselling and relationship skills; holiday and weekend respite; staff trained in cookery skills. 4Staff trained to deal with aggression; detailed care plans drawn up with support from GP and SS; drop in service; carers outings and support groups. 5Family days out with respite cover; trips to Alzheimer's Society Club for loved one; attendance with loved one at day facilities to better understand care needs. Anni Telford 7/9/2011 15

16. Staff Responses Feelings 10 (Strong Positive)987 Shopping in D&GRespiteLittle Gardening Take out Walking or Wheelchair Would like to spend quality time with clientsShop LocallyLittle DIY Want to help more Personal AssistantAssisting Activities Involvement in case conferences Happy to do it Companionship More interaction with staff and managersGood, interestedLetters ChallengingDrivingOvernighters Rewarding 10 (Strong Negative)987 CleaningGardeningGoing DistancesGardening HouseworkDriving Long DistancesGardeningChallenged Under trainedAsk about more payHelplessMore information OvernightOvernight careFight for careAnxious Worried holidays Frustrated Frustrated, not able to be persons advocate Worried about doing 1-1 Anni Telford 7/9/2011 16

17. Staff Responses Support PriorityActivity 1More regular work patterns; more training in dealing with specific clients problems; fewer work pattern changes; small team/client group working and case management meetings. 2More involvement in organisational management and change; better terms and conditions of service including pay; better communications. 3More input from carers on clients care and specific problems; more mileage allowance to cover rural setting; specific training and supervision management. 4Greater flexibility between client/carer and front line staff; less interference from Social Services on what cannot be done; more acknowledgement from NHS and SS statutory staff. 5More training on interventions; more training on counselling and psychological support; greater understanding of PA role. Anni Telford 7/9/2011 17

18. Conclusions 1 Anni Telford 7/9/2011 18 Suggests that there are structural lessons around service user/carer as well as staff involvement in organisational direction and management; Issues around interdisciplinary working between NHS, SS and third sector staff. Greater flexibility and range of services required to meet service user/carer demands for normalised life style

19. Conclusions 2 Anni Telford 7/9/2011 19 Issues around staff organisation to maximise ability to personalise service; Issues around supervision and training; Staff expectations about pay and conditions will have to be negotiated to ensure success of personalisation agenda; Issues around managing service users expectations.

20. References Denscombe, M. (2003 [1998]) The Good Research Guide, Maidenhead, Open University Press. Anni Telford 7/9/2011 20